Individual
JONATHAN SEAN GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20 GLENLAKE PKWY, GLENLAKE MEDICAL OFFICE, ATLANTA, GA 30328-3473
(404) 365-0966
Mailing address
3495 PIEDMONT RD NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305-1717
(404) 364-7070
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
002141
GA
207RC0000X
Cardiovascular Disease Physician
Primary
068164
GA
390200000X
Student in an Organized Health Care Education/Training Program
MD0000045295
TN
Other
Enumeration date
01/30/2008
Last updated
01/07/2022
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